A 9.5-year-old boy from Kolkata, presented to pediatric outpatient department with severe headache and mild fever of one month duration. Headache was bilateral, persistent and associated with neck pain. There were no visual disturbances or any ear discharge. Fever was continuous in nature and gradually increasing in intensity. There was no associated cough, respiratory distress, dysuria, abdominal pain, joint pain or joint swelling, myalgia, convulsion, altered sensorium. His sister was suffering from active pulmonary tuberculosis and she was on antituberculosis drugs for last 2 months. On examination, pulse was 88/min, blood pressure 116/84 mmHg. Temperature was mildly elevated (38.3oC). Patient had no hepatosplenomegaly, no sternal tenderness, and no lymphadenopathy. Sensorium was normal. Neck rigidity was absent. Neither sign of raised intracranial tension nor cranial nerve palsy were noted. Ophthalmoscopic examination was normal. Planter reflex bilaterally flexor. Power and tone in all four limbs were normal. On laboratory examination, hemoglobin 14.2 g/dL, total count 9400/mm 3 (neutrophil 62%, lymphocyte 24%, eosinophil 12%). Liver function tests, urea, creatinine were within normal range. Routine urine examination was normal. Blood and urine culture showed no growth. Malarial dual antigen